The current nonoperative standard in the treatment of tibial fractures begins with reduction of the fracture and application of a bent knee long leg cast. Between about 5 and about 10 days following the fracture the original bent knee long leg cast must be replaced with a second bent knee long leg cast. This is because such casts are nonadjustable and therefore cannot accommodate posttraumatic substance of swelling.
Between about 4 and about 6 weeks after the fracture the second bent knee long leg cast is replaced with a tibial walking cast usually of the patellotendon bearing type. In many instances the first tibial walking cast must be replaced with a second tibial walking cast. This is because the relatively nonfunctional mode of the treatment causes muscle atrophy, i.e., shrinking. Again, due to the rigid nature of the casts which are used in the conventional treatment of tibial fractures any loosening resulting either from substance of swelling or muscle atrophy necessitates cast replacement. Otherwise, the lack of a snug fitting cast may allow the fracture to angulate and heal in a poor position.
The present invention comprises a brace useful in the treatment of tibial fractures which overcomes the foregoing and other problems long since associated with the prior art. In accordance with the broader aspects of the invention the brace includes a shoe portion which is designed to simulate natural walking motion. Side members are rigidly secured to the shoe portion and extend upwardly beyond the ankle joint on opposite sides of the lower leg. Extensions are secured to the upper ends of the side members and extend upwardly therefrom beyond the knee. Adjustable straps are provided for securing the shoe portion to the fore foot, for securing the side members to the lower leg, and for securing the extensions to the portion of the leg extending above and below the knee.
The use of the brace of the present invention in the treatment of tibial fractures provides numerous advantages. First, the patient is treated from fracture to healing with a single device. This fact, coupled with the fact that the time required to fit the patient with the brace of the present invention is considerably less than the time required to fit a conventional cast results in considerable cost savings. When the brace is properly installed the extensions at the upper ends of the side members firmly fix the upper tibial without the need to extend the fracture bracing system above the knee. This allows motion of the knee which is beneficial to the patient.
The brace of the present invention is readily adjustable so that as limb swelling diminishes following the fracture a snug fit is maintained. Furthermore, the system is functional so that less muscle atrophy occurs in the course of patient treatment. Because the treatment is functional, intermittent cyclical loading of the fracture extremity is accomplished, and there is good experimental evidence that this actually hastens and enhances union of the fracture.